Hepatic encephalopathy refers to the changes in the brain that occur in
patients with advanced acute or chronic liver disease. If liver cells are
damaged, certain substances that are normally cleansed from the blood by
the healthy liver are not removed (mainly ammonia, or possibly certain
fatty acids). A patient with chronic hepatic encephalopathy may develop
progressive loss of memory, disorientation, untidiness, and muscular
tremors, leading to a form of chronic dementia. The ingestion of protein
invariably aggravates these symptoms.
The treatment of hepatic encephalopathy involves, first, the removal of all drugs that require detoxification in the liver and, second, the reduction of the intake of protein. Restricting the amount of protein in the diet will generally lower the levels of amino acids and ammonia in the bloodstream and brain. Most physicians advise their patients with this condition to eat only about 40 grams of protein a day, and will prescribe lactulose or neomycin to lower amino acid production. Non-meat proteins, such as those found in vegetables and milk, are also recommended. Certain amino acids are used in treatment, since they are considered less likely to cause mental impairment. A dietary supplement rich in these amino acids is used at many liver treatment centers.
